Nephrolithiasis 2 (part 1 in IM)

Question 1

urine pH is <5.5 (acidic) suggests what stone type?

Answer 1

Uric Acid Stone

Question 2

___ aid in stone expulsion by relaxing ureteral smooth muscle.
For treatment of distal ureteral stones sized >5 mm and ≤10 mm.

Answer 2

Alpha-1 antagonists (tamsulosin)

Question 3

Nephro/Ureterolithiasis complicated by infection (eg, fever, chills) requires urgent _____ because it can rapidly progress from pyelonephritis to severe sepsis and shock.

Answer 3

urologic consultation

Question 4

Other indications for urgent urologic consultation s/t Nephro/Ureterolithiasis include fever/chills, _____ , refractory pain or vomiting, and ____.

Answer 4

acute kidney injury
anuria

Question 5

____ presents with flank pain, low-volume voids (poor urine output) ± intermittent high-volume voids, and ± potassium wasting & dehydration, which can cause weakness.

Answer 5

Obstructive uropathy
(mcc: kidney stones, BPH)

Question 6

Drug-induced rhabdomyolysis can be caused by (8)

Answer 6

Statins /Fibrates
Colchicine
Cocaine / Amphetamines
Opioids / Benzodiazepines
Ethanol

Question 7

No stone passage in ____ requires outpatient Urology consult

Answer 7

4-6 weeks

Question 8

Small stones (≤5 mm) have a high probability of passing with expectant management alone (____).

Answer 8

fluids, pain control

Question 9

Stones that are large (>10 mm), almost always require ____ for resolution.

Answer 9

(outpatient) urologic intervention (lithotripsy, stent placement)

Question 10

_____ of the abdomen and pelvis are the imaging modalities of choice to confirm the diagnosis of Nephrolithiasis.

Answer 10

Ultrasonography or a noncontrast CT scan

(U/S preferred in pregnant or pediatric patients to reduce radiation exposure)

Question 11

Young children may have an atypical presentation of nephrolithiasis with isolated ____ in the absence of abdominal or flank pain.

Renal and bladder ultrasound is the preferred imaging study for diagnosing stones in children.

Answer 11

gross hematuria

Question 12

NBSIM in pediatric patients with glomerular hematuria
(high creatinine, proteinuria)

Answer 12

Complement levels
CBC (if hemolytic cause suspected)

Question 13

Asymptomatic Hematuria in pediatric patients with normal creatinine. NBSIM

Answer 13

Renal U/S
± Urine culture

Question 14

Symptomatic Hematuria in pediatric patients with dysuria or pyuria. Diagnosis and NBSIM

Answer 14

UTI
Urine culture
Antibiotic therapy

Question 15

Symptomatic Hematuria in pediatric patients with perineal/meatal irritation. NBSIM?

Answer 15

Reassurance

Question 16

Pediatric Patient with nonglomerular hematuria + Abdominal mass?
Diagnosis and NBSIM?

Answer 16

Renal mass (Wilms tumor)
Abdominal CT scan

Question 17

____ is often suggested by positive blood on UA, but little to no RBCs per hpf on urine microscopy.

Answer 17

rhabdomyolysis

Question 18

Urine pH >8 (basic) suggests what type of stone?

Answer 18

Struvite (magnesium ammonium phosphate) stones

Question 19

Infections with Klebsiella, Proteus cause what type of stones?

Answer 19

Struvite (magnesium ammonium phosphate) stones

Question 20

Magnesium ammonium phosphate (struvite) causes large kidney stones in patients who have recurrent UTIs with urease-producing organisms (Proteus, Klebsiella).
Antibiotics alone do not eliminate struvite stones & ____ is usually required.

Answer 20

complete stone removal

Question 21

____ complicated by bladder implants typically have cyclic hematuria, dysuria, suprapubic tenderness, and negative urine culture.

Answer 21

Endometriosis

Question 22

A personal history of recurrent kidney stones from childhood and a positive family history for nephrolithiasis should raise suspicion for what diagnosis?
Urinalysis shows hexagonal crystals.

Answer 22

Cystinuria

Question 23

Acute ___ presents with dull, constant, non-radiating flank pain, hematuria, ↑ LDH, ↑ kidney size on imaging (w/o hydronephrosis)

mcc are nephrotic syndrome, malignancy, and trauma.

Answer 23

renal vein thrombosis

(Diagnosis can be confirmed by CT or MR angiography or renal venography)

Question 24

Acute _____ presents with flank + abdominal pain, hematuria, HTN, and wedge-shaped area of ischemia on imaging.
mmc are cardioembolic disease (atrial fibrillation)

Answer 24

renal infarction

Question 25

Renal colic in pregnancy is associated with abdominal pain, flank tenderness, hematuria, and, often, ______.

Answer 25

irregular uterine contractions (get an Ultrasound)

Question 26

In malabsorption syndromes (Crohn disease), there is excess enterically absorbed ___ resulting in **calcium oxalate** stone formation.

Answer 26

Oxalate

Question 27

Increased enteric absorption of calcium, induced by **calcitriol** (the active form of vitamin D), results in hypercalcemia, hypercalciuria, and an increased risk of calcium stones. Commonly seen in what diseases?

Answer 27

hyperparathyroidism Sarcoidosis Granulomatous Diseases

Question 28

Young adult presents with **flank pain & hematuria** that is self resolved. Labs reveal **anemia** and **RBCs** on UA. Increased **renal medullary echogenicity** seen on ultrasound Diagnosis?

Answer 28

Renal Papillary Necrosis (s/t Sickle Cell Trait/Disease)

Question 29

Drugs with **anticholinergic** properties (amitriptyline) can cause acute **urinary retention** by preventing detrusor muscle contraction and urinary sphincter relaxation. The treatment involves ____

Answer 29

urinary catheterization discontinuing the medication

Question 30

____ can affect the genitourinary tract causing **neurogenic bladder** with urinary retention and distended bladder. Patients can then develop **overflow incontinence** (dribbling, poor urinary stream) with a **high post-void residual volume** (>200ml).

Answer 30

Diabetic autonomic neuropathy

Question 31

Patients with **postpartum urinary retention**, the inability to void **≥6 hours** after vaginal delivery, may have dribbling of urine from overflow incontinence. ____ indicated for diagnosis and treatment.

Answer 31

Urethral catheterization

Question 32

Severe ____ can cause recurrent or chronic **pyelonephritis**. Complications include parenchymal scarring, blunted calyces, hypertension, and renal insufficiency.

Answer 32

vesicoureteral reflux (commonly girls)

Question 33

Definitive diagnosis of **vesicoureteral reflux** is made by ____

Answer 33

voiding cystourethrogram

Question 34

The most common cause of chronic renal insufficiency/failure in **male** children. Can present with obstructed urethra, thick/distended bladder, dilated ureters, and Hydronephrosis.

Answer 34

Posterior urethral valves

Question 35

Chronic ____ causes **urinary stasis** and is a risk factor for **recurrent cystitis** in young **children**.

Answer 35

constipation